| NPI | 1477165561 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 13662) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401417125) |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2024-09-19 |